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    <script src="/statics/js/flexible.js"></script>
    <title>医院管理</title>
    <link rel="stylesheet" href="/statics/css/bootstrap.min.css">
    <link rel="stylesheet" href="/statics/css/common.css">
    <link rel="stylesheet" href="/statics/css/complain_patient.css">
</head>
<body>
<div class="container-fluid container-fluid-padding text-center">警情处理</div>

<!--患者基本信息  开始-->
<div class="container-fluid container-fluid-margin-top define-active">
    <div class="row define-list-nav define-border-bottom">
        <div class="col-xs-6"><img src="/statics/images/conplain_patient_info.png" alt=""><span>患者基本信息</span></div>
        <div class="col-xs-6 text-right"><img class="define-drawer-animation" src="/statics/images/conplain_down.png" alt=""></div>
    </div>
    <div class="define-list">
        <div class="row define-list-item define-border-bottom">
            <div class="col-xs-6">姓名</div>
            <div class="col-xs-6 text-right"><!--铜仁宝-->
                <input style="border: none;outline: none;" id="patient_name" class="define-placeholder text-right" type="text" value="" placeholder="请输入姓名">
            </div>
        </div>
        <div class="row define-list-item define-border-bottom">
            <div class="col-xs-6">性别</div>
            <div class="col-xs-6 text-right" id="picker-sex"><span>男</span><img class="define-right" src="/statics/images/conplain_right.png" alt=""></div>
        </div>
        <div class="row define-list-item define-border-bottom">
            <div class="col-xs-6">年龄</div>
            <div class="col-xs-6 text-right"><!--25-->
                <input style="border: none;outline: none;" id="patient_age" class="define-placeholder text-right" type="number" value="" placeholder="请输入年龄">
            </div>
        </div>
        <div class="row define-list-item define-border-bottom">
            <div class="col-xs-6">住院号</div>
            <div class="col-xs-6 text-right"><!--A888-->
                <input style="border: none;outline: none;" id="patient_hos_number" class="define-placeholder text-right" type="text" value="" placeholder="请输入住院号">
            </div>
        </div>
        <div class="row define-list-item define-border-bottom">
            <div class="col-xs-6">门/急诊号</div>
            <div class="col-xs-6 text-right"><!--A666-->
                <input style="border: none;outline: none;" id="patient_emegency_number" class="define-placeholder text-right" type="text" value="" placeholder="请输入门/急诊号">
            </div>
        </div>
        <div class="row define-list-item define-border-bottom">
            <div class="col-xs-6">联系电话</div>
            <div class="col-xs-6 text-right"><!--13556565656-->
                <input style="border: none;outline: none;" id="patient_phone" class="define-placeholder text-right" type="number" value="" placeholder="请输入联系电话">
            </div>
        </div>
        <div class="row define-list-item define-border-bottom">
            <div class="col-xs-6">医保类型</div>
            <div class="col-xs-6 text-right" id="picker-health-insurance-status"><span>请选择</span><img class="define-right" src="/statics/images/conplain_right.png" alt=""></div>
        </div>
        <div class="row define-list-item define-border-bottom">
            <div class="col-xs-6">患者来源</div>
            <div class="col-xs-6 text-right"><!--来源-->
                <input style="border: none;outline: none;" id="patient_source" class="define-placeholder text-right" type="text" value="" placeholder="请输入患者来源">
            </div>
        </div>
        <div class="row define-list-item define-border-bottom">
            <div class="col-xs-6">身份证号</div>
            <div class="col-xs-6 text-right"><!--410411********5566-->
                <input style="border: none;outline: none;" id="patient_idcard" class="define-placeholder text-right" type="text" value="" placeholder="请输入身份证号">
            </div>
        </div>
        <div class="row define-list-item define-border-bottom">
            <div class="col-xs-6">医保号</div>
            <div class="col-xs-6 text-right"><!--A999-->
                <input style="border: none;outline: none;" id="patient_medical_number" class="define-placeholder text-right" type="text" value="" placeholder="请输入医保号">
            </div>
        </div>
        <div class="row define-list-item define-border-bottom">
            <div class="col-xs-6">家属姓名</div>
            <div class="col-xs-6 text-right"><!--铜仁宝-->
                <input style="border: none;outline: none;" id="relation_name" class="define-placeholder text-right" type="text" value="" placeholder="请输入家属姓名">
            </div>
        </div>
        <div class="row define-list-item define-border-bottom">
            <div class="col-xs-6">家属手机号</div>
            <div class="col-xs-6 text-right"><!--13556565656-->
                <input style="border: none;outline: none;" id="relation_phone" class="define-placeholder text-right" type="number" value="" placeholder="请输入家属手机号">
            </div>
        </div>
        <div class="row define-list-item define-border-bottom">
            <div class="col-xs-6">疾病/住院危害程度</div>
            <div class="col-xs-6 text-right" id="picker-extent-of-injury"><span>较轻</span><img class="define-right" src="/statics/images/conplain_right.png" alt=""></div>
        </div>
        <div class="row define-list-item">
            <div class="col-xs-6">患者家属合作态度</div>
            <div class="col-xs-6 text-right" id="picker-collaborative-attitude"><span>配合</span><img class="define-right" src="/statics/images/conplain_right.png" alt=""></div>
        </div>
    </div>
</div>
<!--患者基本信息  结束-->

<!--相关医护人员  开始-->
<div class="container-fluid container-fluid-margin-top">
    <div class="row define-list-nav define-border-bottom">
        <div class="col-xs-6"><img style="width: 0.4rem;" src="/statics/images/conplain_medical_workers.png" alt=""><span>相关医护人员</span></div>
        <div class="col-xs-6 text-right"><img class="define-drawer-animation define-close-active" src="/statics/images/conplain_down.png" alt=""></div>
    </div>
    <div class="define-list">
        <div class="row define-list-item define-border-bottom">
            <div class="col-xs-6">医护类型</div>
            <div class="col-xs-6 text-right" id="picker-medical-type"><span>请选择</span><img class="define-right" src="/statics/images/conplain_right.png" alt=""></div>
        </div>
        <div class="row define-list-item">
            <div class="col-xs-4">姓名</div>
            <div class="col-xs-8 text-right"><!--铜人宝-->
                <input style="border: none;outline: none;" id="hos_name" class="define-placeholder text-right" type="text" value="" placeholder="请输入姓名">
            </div>
        </div>
    </div>
</div>
<!--相关医护人员  结束-->

<!--患者病情严重程度与行为部分情况统计  开始-->
<div class="container-fluid container-fluid-margin-top">
    <div class="row define-list-nav define-border-bottom">
        <div class="col-xs-12"><img style="width: 0.4rem;" src="/statics/images/conplain_warning.png" alt=""><span>患者病情严重程度与行为部分情况统计</span></div>
        <div class="text-right define-col"><img class="define-drawer-animation define-close-active" src="/statics/images/conplain_down.png" alt=""></div>
    </div>
    <div class="define-list">
        <div class="row define-list-item define-border-bottom">
            <div class="col-xs-6">患者病情程度</div>
            <div class="col-xs-6 text-right" id="picker-illness-degree"><span>轻</span><img class="define-right" src="/statics/images/conplain_right.png" alt=""></div>
        </div>
        <div class="row define-list-item define-border-bottom">
            <div class="col-xs-8">演变成医患纠纷/医闹可能性</div>
            <div class="col-xs-4 text-right" id="doctors-and-patients"><span>无</span><img class="define-right" src="/statics/images/conplain_right.png" alt=""></div>
        </div>
        <div class="row define-list-item define-border-bottom">
            <div class="col-xs-8">是否存在医疗不当投诉</div>
            <div class="col-xs-4 text-right" id="picker-complain-mala-praxis"><span>无</span><img class="define-right" src="/statics/images/conplain_right.png" alt=""></div>
        </div>
        <div class="row define-list-item define-border-bottom">
            <div class="col-xs-8">是否存在护理不周投诉</div>
            <div class="col-xs-4 text-right" id="picker-complain-loose-care"><span>无</span><img class="define-right" src="/statics/images/conplain_right.png" alt=""></div>
        </div>
        <div class="row define-list-item define-border-bottom">
            <div class="col-xs-8">患者及家属语言行为</div>
            <div class="col-xs-4 text-right" id="picker-relation-speech-act"><span>轻</span><img class="define-right" src="/statics/images/conplain_right.png" alt=""></div>
        </div>
        <div class="row define-list-item define-border-bottom">
            <div class="col-xs-8">患者及家属肢体动作</div>
            <div class="col-xs-4 text-right" id="picker-relation-body-cont"><span>轻</span><img class="define-right" src="/statics/images/conplain_right.png" alt=""></div>
        </div>
        <div class="row define-list-item">
            <div class="col-xs-8">患者及家属对医院有误投诉</div>
            <div class="col-xs-4 text-right" id="picker-complain-error"><span>无</span><img class="define-right" src="/statics/images/conplain_right.png" alt=""></div>
        </div>
    </div>
</div>
<!--患者病情严重程度与行为部分情况统计  结束-->

<!--提交  开始-->
<div class="container-fluid container-fluid-margin-top text-center" id="post">
    提交
</div>
<!--提交  结束-->

<div class="define-mark" id="define-mark"></div>

<!--模态框  开始-->
<div class="modal fade bs-example-modal-lg" id="myLargeModalLabel" tabindex="-1" role="dialog" aria-labelledby="myLargeModalLabel">
    <div class="modal-dialog modal-lg" role="document">
        <div class="modal-content text-center">
            表单提交成功!
        </div>
    </div>
</div>
<!--模态框  结束-->

<!--form表单  开始-->
<form action="" style="display: none;" id="post_form">
    <!--患者基本信息-->
    <input type="text" name="name" value=""><!--姓名-->
    <input type="text" name="sex" value="1"><!--性别-->
    <input type="text" name="age" value=""><!--年龄-->
    <input type="text" name="hospital_num" value=""><!--住院号-->
    <input type="text" name="outpatient_num" value=""><!--门/急诊号-->
    <input type="text" name="phone" value=""><!--联系电话-->
    <input type="text" name="insurance_type" value=""><!--医保类型-->
    <input type="text" name="source" value=""><!--患者来源-->
    <input type="text" name="idCard" value=""><!--身份证号-->
    <input type="text" name="medical_insurance" value=""><!--医保号-->
    <input type="text" name="relation_name" value=""><!--家属姓名-->
    <input type="text" name="relation_phone" value=""><!--家属手机号-->
    <input type="text" name="illness_severity" value="无"><!--疾病/住院危害程度-->
    <input type="text" name="relation_attitude" value="配合"><!--患者家属合作态度-->

    <!--相关医护人员-->
    <input type="text" name="medical_type" value=""><!--医护类型-->
    <input type="text" name="medical_workers" value=""><!--姓名-->

    <!--患者病情严重程度与行为部分情况统计-->
    <input type="text" name="illness_level" value="轻"><!--患者病情程度-->
    <input type="text" name="dispute_possibility" value="无"><!--演变成医患可能性-->
    <input type="text" name="medical_complain" value="无"><!--是否存在医疗不当投诉-->
    <input type="text" name="care_complain" value="无"><!--是否存在护理不周投诉-->
    <input type="text" name="speak_level" value="轻"><!--患者及家属语言行为-->
    <input type="text" name="action_level" value="轻"><!--患者及家属肢体动作-->
    <input type="text" name="hospital_complain" value="无"><!--患者及家属对医院有误投诉-->
</form>
<!--form表单  结束-->

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<script type="text/javascript" src="/statics/js/mui.min.js"></script>
<script type="text/javascript" src="/statics/js/mui.picker.js"></script>
<script type="text/javascript" src="/statics/js/mui.poppicker.js"></script>
<script type="text/javascript" src="/statics/js/complain_waring_handle.js"></script>
</body>
</html>